Management of ventricular tachycardias: insights on centre settings, procedural workflow, endpoints, and implementation of guidelines—results from an EHRA survey

Abstract Ventricular tachycardia (VT), and its occurrence, is still one of the main reasons for sudden cardiac death and, therefore, for increased mortality and morbidity foremost in patients with structural heart [Kahle A-K, Jungen C, Alken F-A, Scherschel K, Willems S, Pürerfellner H et al. Management of ventricular tachycardia in patients with ischaemic cardiomyopathy: contemporary armamentarium. Europace 2022;24:538–51]. Catheter ablation has become a safe and effective treatment option in patients with recurrent VT [Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2020;17:e2–154]. Previous and current guidelines provide guidance on indication for VT ablation and risk assessment and evaluation of underlying disease. However, no uniform recommendation is provided regarding procedural strategies, timing of ablation, and centre setting. Therefore, these specifics seem to differ largely, and recent data are sparse. This physician-based European Heart Rhythm Association survey aims to deliver insights on not only infrastructural settings but also procedural specifics, applied technologies, ablation strategies, and procedural endpoints. Therefore, these findings might deliver a real-world scenario of VT management and potentially are of guidance for other centres.


Introduction
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Survey on VT Ablation_2 is your country? 3. How many ablations overall are performed at your centre/year? of physicians performing VT ablation on a regular basis?6.How many VT ablation/year (including outflow tract VT) are performed?7. Which percentage of your VT ablation is performed in patients with ICM? ICE is available when do you use it?14.Do you perform coronary angiography before VT ablation? is your favored medication/treatment for acute treatment in VT or VT answers possible, please indicate ranking if answered multiple) Amiodarone (de novo or escalation) Lidocaine Ajmaline Mexiletine Non-selective ß-Blocker stellate ganglion blockade/sympathectomy Intubation and deep sedation Pre and Post Ablation Survey on VT Ablation_2 17. Do you stop (D)OAC/DAPT before procedure Yes No 18.If you stop, how long before procedure (in hours)?0 48 19.What is your (D)OAC/Antiplatelet of choice after ablation (no AF indication)?20.How long do you prescribe (D)OAC/Antiplatelet (in weeks)?0 52 What is your AAD regime and/or use of LifeVest post ablation Survey on VT Ablation_2 21.Do you always stop AAD after successful ablation Yes No Sometimes 22. Do you continue AAD for at least 3 month after successful ablation?you use LifeVest in patients with preserved LV-Fx after VT ablation?Yes No 24.When do you perform VT ablation in "first do" procedures in ischemic cardiomyopathy patients (ICM)?After the first shock After multiple shocks Increasing nsVT or ATP episodes "Prophylactic ablation" irrespective of ICD intervention 25.When do you perform VT ablation in "first do" procedures in Non-ICM?After the first shock After multiple shocks Increasing nsVT or ATP episodes "Prophylactic ablation" irrespective of ICD intervention 26.Based on what do you decide to use an assist device for VT ablation?I-VT Score/PAINESD Score Patient in VT storm Severely impaired LV function 27.In case of ablation failure does centre have access to any of the following advanced ablation technique listed?but cooperation and/or referral option in my country Not available in my country All that applies 28.What do you use for vascular access and access closure?US-guided puncture Z-suture for venous access Closure device (e.g.AngioSeal) for arterial access Closure device for venous access Manual compression only 29.In which cases do you perform genetic testing?In all DCM/HNDCM cases In DCM/HNDCM patients with family history of DCM/HNDCM or SCD (<50 years) In DCM/HNDCM patients with AV conduction abnormalities I do not consider genetic testing valuable in this setting 30.Do you perform EP Study for VT/SCD risk assessment?No Only in patients with first SMVT episode Only in symptomatic (syncope/dizziness) patients with known SHD Procedural specifics (Part B) Survey on VT Ablation_2 31.How do you obtain access to the LV in the vast majority of your cases?Always retrograde aortic and transseptal access Starting retrograde aortic access only Starting transseptal access only 32.When do you opt for an access beforehand (procedure start) ?would you describe your procedural workflow (multiple answers possible)?Electro-anatomical mapping and VT induction attempt High-Density Mapping routinely No induction attempt, substrate-based ablation (HD map/MRI/CT based) ILAM-, DEEP-, LAVA-mapping guided ablation Other (please specify) 34.Which mapping catheter do you use for electro-anatomical mapping?Do you use ablation index or lesion size index (knowing its validation for LA only)?When do you perform advanced ablation techniques (e.g.bipolar -please see Part)?Only in case of repeat ablation after initial failure (second procedure)In first procedure if VT documentation or disease entity implies (e.g.NICM)Not available in my centre 44.If needed, which assist device do you use the most frequently?
39. What is you target AI value (your max.value please) 40.What it your target LSI value (your max.value please) 41.What is your AI value ?